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Child Separation Anxiety

If you have found your way to this page, you are likely to be concerned about your child's issues with separation anxiety. On this page you can learn a bit about separation anxiety. I will explain the difference between child separation anxiety and  separation anxiety disorder, help you figure out some strategies to help your child and help you determine whether you need to seek professional help. 

Criteria for Child Separation Anxiety Disorder

Let's look at the actual diagnostic criteria for Child Separation Anxiety Disorder in the manual that medical professionals use, the  DSM V. 

A child must have:

A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.

  1. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
  2. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
  3. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
  4. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
  5.  Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
  6.  Repeated nightmares involving the theme of separation
  7.  Repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

C. The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

D. The disturbance does not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and, in adolescents and adults, is not better accounted for by panic disorder with agoraphobia.

How Do I Know if My Child has Child Separation Anxiety Disorder

Child separation anxiety can be a part of normal development  or it can be a more serious indication of an issue you need to pay attention to.

Is your child:

  • Refusing to go to school?
  • Having serious trouble sleeping or nightmares to the point that they will not sleep alone?
  • Complaining about frequent stomachaches or other physical problems and avoiding doing activities where they are separated from you ?
  • Worrying about you being harmed?
  • Having some much worry that it is interfering with your work or daily activities?
  • Afraid they might come home and you won’t be there and so refusing to do fun things?
  • Forcing you to alter your activities or work schedule because of the anxiety?

If this describes your child he or she is most likely suffering from Child Separation Anxiety Disorder. Usually if the behaviors are interfering with the fun things that kids do, or the  normal things that kids do, we start to think of it as an anxiety disorder and not just separation anxiety.

Developmental stages are also important to consider when determining whether child separation anxiety is normal or more of a problem. Let's look at some ages and stages where separation anxiety is normal. 

Infant or Baby Separation Anxiety

Infants normally will show signs of distress during the latter half of the first year of life, and the second and sometimes third year of life as well. Sometime between around 6 to 12 months a baby will begin to develop stranger anxiety, and will demonstrate a preference for  their mother over other people. This may disappear and resurface at different times over the next two years. This is normal and expected. Actually, baby separation anxiety is a sign of healthy attachment to the mom, so this is a good thing! In fact, if we didn’t see some anxiety in infants during a mom's absence it would probably be concerning because it would suggest a possible disruption to the normal attachment process. 

However, if you feel your baby’s anxious behavior is excessive and is not easily alleviated, trust your instinct, it may be a sign that your child is in some kind of physical distress. Check in with a medical doctor at this point if you have still concerns. 

Separation Anxiety in Toddlers

Separation Anxiety is also often seen around toddler and preschool ages as well. Children may act distressed or upset at this age when separated from you, but this usually is temporary.

For example, if you drop your toddler off at preschool and they act wary at drop off are hesitant to take their coat off for a few weeks this is not abnormal. Often day care centers even have programs that help toddlers get adjusted to programs gradually in order  to help take these normal stages of toddler development  into consideration.

If it's been a many weeks, and your child refuses to interact  or take their coat off, than you have a more serious problem.

By preschool  and kindergarten years it becomes easier to distinguish normal  child separation anxiety from separation anxiety disorder. 

If your child's anxiety is not disruptive to your life or your child's daily routine it may not be too concerning. As with younger children, a good rule of thumb for determining if it has risen to the level of something more serious is  to ask yourself  "Is it  interfering in your child’s ability to be happy and successful at home, socially or academically?"

If your child avoids pleasant activates that other children engage in, is afraid to go to school, or frequently expresses irrational fears about you dying or leaving them, the anxiety should be probably be evaluated by a professional. The good news is most kids with child separation anxiety disorder who get help can be fine!


Causes of Separation Anxiety in Kindergarten 

Other issues that may prompt some normal and expected separation anxiety are as follows :

  • Any loss trauma of change such as divorce, a death or a move. 
  • An illness or hospital visit for an injury that can make a child concerned for their parents safety 
  • Learning disabilities or poor social skills can contribute to a child's struggles to fit in school or be successful academically. Then the anxiety may be developed as a way to protect them from that stress
  • Children who have disturbed early attachment from the first few years of life might show signs of separation anxiety. A child who has has spent time in foster care or been adopted during the first three years of life for example. 
  • The normal attachment cycle consists of children crying when distressed and response being soothed by their mother. This creates a sense of safety trust and certainty that the child will be taken care of. When this is disrupted, anxiety can result. 


Other issues that can be expected to cause some separation anxiety:

  • A new babysitter,
  • School change
  • Stress in the family
  • Divorce or death in the family
  • A move to a new home
  • Any new or big transition.

Again, a good rule of thumb is if the anxiety does not resolve itself within a short time or begins to have a serious impact on your child's functioning, it might be time to start to view this as more serious, and perhaps seek consultation from a professional. 

Teenage Separation Anxiety

Teenage and young adult separation anxiety, although less common, can also be an issue. This anxiety can prevent teens from establishing the independence and self reliance that is so critical at this point.

Most cases of teenage separation anxiety may have had  an earlier onset that went diagnosed. As mentioned earlier,  The DSM 4 stated that the onset of separation anxiety must be prior to 18, changes in the DSM 5  include a late onset and are beginning to  expand our understanding of the illness. We are awaiting new research to help us with treatment advances. 

Teens with separation anxiety:

  •  Avoid being alone away from the person they are attached to
  •  May be preoccupied with being separated from a loved one
  •  May worry about someone they care about being harmed
  •  May worry about some event occurring which may cause separation from their loved one
  •  May want to stay by the loved ones side and be resistant to situations which cause them to be separated from the person they are attached to.
  • May avoid doing activities where they are separated from the person that they are attached to, thus limiting functionality in their lives

You can imagine how disruptive this could be to a teens life! Not only may these feelings prevent them from going to school, but from working, having normal social and peer relationships, and accomplishing the tasks of normal adolescents.

Adolescence is a time when children separate from their parents and define their individuality, and they come to identify more with their peers that their family. Separation anxiety can disrupt this entire process and prevent the normal development necessary for teens to become happy fulfilled and productive adults.

It is important to note that with teens the object of their attachment may be a person other than their parent, such as friend or boyfriend..

It may be that panic disorder or social anxiety is confused with separation anxiety and so it is important that the teen’s anxiety is actually a result of fear of being separated from an attachment figure for that diagnosis to be made. Regardless of the actual diagnosis, a teen experiencing anxiety which is interfering in their ability to be successful in any arena of their life needs help!

Treatment for Teens with Separation anxiety

  • Cognitive Behavior Therapy:The teen is taught how to  change the unhealthy thinking that contributes to anxiety, the teenager is helped to recognize the thoughts driving the anxiety, and learn how to interfere in that cycle by changing those thoughts. Other techniques would be taught to help the teen cope with and manage that anxiety.
  • Relaxation/ Systematic Desensitization:The teen is taught how to relax physically while imagining the fearful situations that cause them so much stress thus aiding in the decrease of the anxiety. This is called systematic desensitization.
  • Exposure: The teen is encouraged with the help of the family to gradually face and conquer the fears that are preventing them from enjoying a normal life.
  • Work with the figure of attachment to discover how some of their own behavior patterns might be enabling the teens illness.

Child Separation Anxiety and Other issues

Children who have separation anxiety are 90 percent more likely to have at least one sleep related issue( Chase and Pincus 2011) and 75 percent of children who have separation anxiety will have school refusal ( Bernstein 2016).

Additionally, research adults who have other mental health issues have had separation anxiety as a child. It's important if you think you child has separation anxiety disorder to consult with a professional. Don't let it go on too long.

What can I do to help my child who has Child Separation Anxiety ?

How are you enabling your child?

Because parents love their children, they  most often want to protect them from any pain, and that includes the discomfort of unpleasant emotions. 

Four things things you can do to help your child with their separation anxiety are:

1) Avoid your tendency to reassure them. This discourages them from developing the tools they need to handle their anxiety and tolerate it. 

2) Explore whether you are avoiding activities that they are able to do.This gives children the message that they are not capable and strong enough to do things

3. Explore whether you are modeling managing your own anxiety with avoidance. Often parents have their own issues with anxiety they need to work through. 

4. Take stock of whether you are negatively reinforcing your child by  scolding or giving attention to the crying, whining or anxious behaviors when they exhibit it. This is more likely to increase anxious behavior. 

It is our job as parents to recognize and verbalize how a child is feeling and encourage them that they can handle these feelings. Parents very frequently underestimate their child's ability to cope and don't give their children a chance to learn how to beat their anxiety. They wind up being being overprotective and sending the message to their children that they do not have confidence in their ability to handle the anxiety, and unintentionally reinforce it. Parents in the short run might lower anxiety by reassuring them and helping  them to avoid activities that cause them anxiety however, in the long run this exacerbates the problem. Also, parents who have their own anxiety may model avoidance behavior. New research on treatment methods focusing on parents are showing that therapy targeting these tendencies can decrease children's anxiety dramatically, even when the children are NEVER SEEN IN THERAPY!

Click here if you are interested in learning about treatment for childhood separation anxiety 

Click here if you are interested in learning about sleep problems related to childhood separation anxiety

Check out our online facebook support community for parents of kids with mood disorders 

American Psychiatric Association. (2013). Anxiety Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).

Chase, R.M., & Pincus, D.B. (2011). Sleep-related problems in children and adolescents with anxiety disorders. Behavioral sleep medicine, 9 4, 224-36 .

Bernstein, B. E. (2016) Separation anxiety and school refusal. Medscape, October 6, 2016.

Have A Great Question About This Topic?

Do you have a question about separation anxiety in children? I get several emails a day asking questions about anxiety disorder in children. Many parents have the same concerns and issues. Help others with questions by sharing your question about anxiety in children, or about symptoms of anxiety in your child.

It may be helpful to include any ideas or techniques you have tried to help your child's anxiety and whether or not they have worked.

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